摘要
目的 观察常规剂量肝素体外循环 (CPB)中 ,使用肝素涂层CPB管道对围体外循环期间凝血 抗凝血酶的变化 ,确定肝素涂层装置对CPB的血液保护作用。方法 机械瓣膜置换术患者随机分为HCC组 (n =8)和对照组 (n =1 5 )。分别在CPB前、CPB6 0min、中和后 30min和 6 0min ,及手术后 1 2h测定血小板计数 (PLC) ,血浆α颗粒膜蛋白 1 4 0 (GMP 1 4 0 )的浓度 ,及血浆凝血因子Ⅹ (FⅩa)和抗凝血酶Ⅲ (AT Ⅲa)活性。记录手术后 1 2h胸管引流量。结果 对照组PLT在转流中、后显著低于HCC组 (P <0 .0 5 ) ;且血浆GMP 1 4 0浓度在转流 6 0min ,中和后 30min和 6 0min显著高于HCC组 (P <0 .0 5 ) ,但手术后 1 2h没有显著性差异 ;HCC组Ⅹa活性在围术期较对照组有较好的保持 (P <0 .0 5 ) ,而AT Ⅲa在两组没有明显差异。HCC组手术后 1 2h出血量较对照组少 (P <0 .0 5 )。结论 HCC在围CPB期间对血小板、凝血酶活性具有保护作用 。
Objective To investigate the perioperative changes of the platelet, Factor Ⅹ and antithrombin Ⅲ activity using heparin coated circuits(HCC) during cardiopulmonary bypass.Methods Twenty three patients of heart valve replacement were studied. The system heparin dose was 3 mg/kg in the control group (n=15) and heparin coated circuits in the HCC group (n=8). Platelet count, a granule membrane protein 140 (GMP 140) concentrations and activity of Factor Ⅹ(FⅩa) and antithrombin Ⅲ(AT Ⅲa) were determined before CPB, at 60 minutes of CPB, at 30 and 60 minutes after protamine administration, at first 12 hour of CPB, respectively.Results There was significant reduction of platelet loss during and after CPB in the HCC group in contrast to the control group ( P <0.05), GMP 140 in the HCC group was lower than the control group during CPB ( P <0.05). HCC results in a significantly higher values of Factor Ⅹ activity than in the control group during CPB, no differences was observed in the antithrombin Ⅲ activity. During the first 12 hour, postoperative blood loss was reduced in the HCC group as compared with that in the control group (218±61ml, vs. 332±118ml, P <0.05).Conclusions Heparin coated CPB circuits improve postoperative haemostasis during heart surgery, as reflected by significantly reduce the platelet loss and preserve the Factor Ⅹ activity perioperative CPB.
出处
《中国血液流变学杂志》
CAS
2004年第2期175-177,共3页
Chinese Journal of Hemorheology
基金
湖北省科技攻关课题 ( 2 0 0 2AA3 0 1C2 8)